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Background: Response to the current available treatments of melasma, dermal type, in particular, is usually gradual and can result in possible side effects. Aim and Objectives: In this study, we aim to evaluate the efficacy of the combination of plasma rich in growth factors (PRGF) and topical 4% hydroquinone (HQ) in comparison with monotherapy using topical 4% HQ alone in the treatment of dermal type of melasma. Materials and Methods: This is a single-blinded, randomized, split-face clinical trial on twenty female patients with dermal type of melasma. Patients were asked to apply topical 4% HQ on both sides of their face at night for 6 months. In each participant, one side of the face was randomly chosen to receive monthly intradermal injections of PRGF for 3 sessions. Efficacy of the treatment was assessed using hemi melasma area and severity index (MASI) score, physician's global assessment (PGA), and patients' global assessment (PtGA). Results: Both groups revealed significant improvement in hemi-MASI score during the treatment course. Mean percentage of improvement at the end of study was 40.38 ± 6.04% and 33.42 ± 3.23% in the combination therapy and monotherapy groups, respectively (P = 0.31). PGA demonstrated excellent-to-marked improvement in melasma in 25% and 5% of patients in the combination therapy and monotherapy groups, respectively (P = 0.31). PtGA showed high levels of satisfaction in 15% of patients in the combination therapy group (vs. 0% in the monotherapy group) (P = 0.05). Conclusion: Differences between the two treatment groups in terms of hemi-MASI and PGA scores were not statistically significant; however, patients demonstrated higher satisfaction with combination of PRGF and topical 4% HQ compared with topical HQ alone. Thereby, combination of PRGF and topical 4% HQ can be suggested as a safe alternative therapeutic approach and may hold promise in the development of future therapeutic options for dermal type of melasma.
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PURPOSE: Obesity exerts negative effects on pulmonary function through proven mechanical and biochemical pathways. Multiple studies have suggested that bariatric surgery can improve lung function. However, the timing of these effects on lung function and its association with patient reported outcomes is not known. MATERIALS AND METHODS: A prospective cohort study of patients undergoing laparoscopic sleeve gastrectomy (LSG) at a tertiary care hospital was undertaken. Spirometry tests, laboratory tests, and self-reported questionnaires on asthma symptoms and asthma control (ACQ and ACT) were administered. All data were recorded pre-operatively (T0) and every 3 months post-operatively for 1 year (T3, T6, T9, T12) and were compared using a mixed-models approach for repeated measures. RESULTS: For the 23 participants, mean age was 44.2 ± 12.3 years, mean BMI was 45.2 ± 7.2 kg/m2, 18(78%) were female, 9(39%) self-reported as non-white and 6(26%) reported to have asthma. Following LSG, % total body weight loss was significant at all follow-up points (P < 0.0001). Rapid improvement in forced expiratory volume (FEV)% predicted and forced vital capacity (FVC)% predicted was seen at T3. Although the overall ACQ and ACT score remained within normal range throughout the study, shortness of breath declined significantly at 3 months post-op (P < 0.05) and wheezing resolved for all patients by twelve months. Patients also reported reduced frequency of sleep interruption and inability to exercise by the end of the study (P < 0.05). CONCLUSION: Improvements in objective lung function assessments and patient-reported respiratory outcomes begin as early as 3 months and continue until 12 months after sleeve gastrectomy.